2A-Adrenoceptors Modulate Renal Sympathetic Neurotransmission and Protect against Hypertensive Kidney Disease.

Background: Increased nerve activity causes hypertension and kidney disease. Recent studies suggest that renal denervation reduces BP in patients with hypertension. Renal NE release is regulated by prejunctional 2A-adrenoceptors on sympathetic nerves, and 2A-adrenoceptors act as autoreceptors by binding endogenous NE to inhibit its own release. However, the role of 2A-adrenoceptors in the pathogenesis of hypertensive kidney disease is unknown.

Methods: We investigated effects of 2A-adrenoceptor-regulated renal NE release on the development of angiotensin II-dependent hypertension and kidney disease. In uninephrectomized wild-type and 2A-adrenoceptor-knockout mice, we induced hypertensive kidney disease by infusing AngII for 28 days.

Results: Urinary NE excretion and BP did not differ between normotensive 2A-adrenoceptor-knockout mice and wild-type mice at baseline. However, NE excretion increased during AngII treatment, with the knockout mice displaying NE levels that were significantly higher than those of wild-type mice. Accordingly, the 2A-adrenoceptor-knockout mice exhibited a systolic BP increase, which was about 40 mm Hg higher than that found in wild-type mice, and more extensive kidney damage. In isolated kidneys, AngII-enhanced renal nerve stimulation induced NE release and pressor responses to a greater extent in kidneys from 2A-adrenoceptor-knockout mice. Activation of specific sodium transporters accompanied the exaggerated hypertensive BP response in 2A-adrenoceptor-deficient kidneys. These effects depend on renal nerves, as demonstrated by reduced severity of AngII-mediated hypertension and improved kidney function observed in 2A-adrenoceptor-knockout mice after renal denervation.

Conclusions: Our findings reveal a protective role of prejunctional inhibitory 2A-adrenoceptors in pathophysiologic conditions with an activated renin-angiotensin system, such as hypertensive kidney disease, and support the concept of sympatholytic therapy as a treatment.